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Biomedical subjects

C Estève

Publications and source records attributed to C Estève.

At least 19 recordsLinked to original sources
PubMed1991

[Patient-controlled analgesia in children].

This study describes the author's initial experience with "patient controlled analgesia" (PCA) in thirty school-age children for postoperative pain relief after major orthopedic surgery. The only narcotic used was morphine administered at both continuous and PCA modes. After the first eight patients, dosage regimens were changed and satisfactory postoperative analgesia was obtained in the last 20 patients with few side-effects. Recommended dosages range between 0.1 and 0.2 mg.kg-1 for loading dose, 0.01-0.02 mg.kg-1.h-1 for continuous infusion and 0.01-0.02 mg.kg-1 for PCA dose. Interest and limits of this method in children are discussed.

Adolescent↗
PubMed1990

Rectal flunitrazepam as premedication in preschool children. A double-blind randomized study.

The efficacy of flunitrazepam (0.04 mg.kg-1) as a premedicant was evaluated in 40 young children of less than 5 years of age in a double-blind, placebo-controlled study. Flunitrazepam was given by the rectal route 15 min prior to an inhalational mask induction with halothane. Sedation score, mask acceptance and induction score were significantly better in premedicated children than in the placebo group. There were no hypoxic episodes, prolonged sedation or other complications in either group. This suggests that flunitrazepam administered rectally in a low dose is an acceptable premedication in young children.

Administration, Rectal↗
PubMed1989

[Hormonal changes induced by etomidate in children during the first 24 postoperative hours].

The hormonal effects of an etomidate infusion were assessed postoperatively in children undergoing hypospadias or clubfoot repair. The study was carried out in 12 children, aged between 9 and 70 months, randomly assigned to two equal groups. The anaesthetic protocol was identical for all the children, consisting in a light general anaesthesia (halothane induction, intubation after 60 to 80 micrograms.kg-1 vecuronium) combined with lumbar epidural anaesthesia (initial dose of 0.75 ml.kg-1 bupivacaine with adrenaline, with repeat injections of half the previous dose when there was a change in the haemodynamic parameters suggesting inadequate analgesia). Anaesthetic maintenance was different in both groups: 1 to 1.5 vol% enflurane in a nitrous oxide-oxygen mixture (1/1 v/v) in the control group, and 16.8 +/- 3.0 mg.kg-1.min-1 etomidate infusion in the etomidate group. Venous blood samples were collected after induction of anesthesia (before starting the epidural anaesthesia and the etomidate infusion), at the end of surgery (H0), at the 3rd (H3), 6th (H6), 12th (H12) and 24th h (H24) following surgery. The following hormonal blood concentrations were measured: cortisol, 11 beta-desoxycortisol, aldosterone, 11 beta-desoxycorticosterone, dehydroepiandrosterone (DHA) and DHA sulphate (DHA-S). In the control group, cortisol and DHA-S concentrations decreased significantly at H0, aldosterone levels also being significantly lower at H24. In the etomidate group, cortisol concentrations remained significantly lower at H0, H3 and H6; aldosterone concentrations were also significantly lower than control values throughout the study period. There was an important prolonged rise in the concentrations of their precursors. DHA and DHA-S concentrations did not change in the etomidate group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMed1987

[Permeability of venous aortocoronary bypasses one year after their implantation].

For a short-term evaluation of the patency of aortocoronary bypass vein grafts, 54 consecutive patients who underwent this operation alone were examined, irrespective of their functional state, 12.4 +/- 2.1 months after surgery. Examinations included coronary arteriography, selective opacification of the graft and ventriculography. The patients were 47 men and 7 women who had coronary arteriography for stable angina pectoris (22.4%) or a recent episode of unstable angina (59.3%) or a recent myocardial infarction (18.5%). Coronary arteriography showed one-vessel (5.5%), two-vessel (27.8%) or three-vessel (42.6) disease or stenosis of the main left coronary artery (24.1%). The mean number of distal anastomoses in multiple-vessel patients was 2.6. Peri-operative mortality was 1.04%, and the proportion of peri-operative electrocardiographic signs of necrosis was 11%. At the time of control examination, 82% of the patients had few or no symptoms, and 88% were improved by at least one functional class. 79% (97/123) of distal venous anastomoses were patent. All anastomoses were patent in 59% (22/54) and all were occluded in 7% (4/54) of the patients. Localized stenosis of the graft was found in 11% and diffuse stenosis in 4% of the cases. The patency of vein grafts was higher when the distal bed was of normal size than when it was small or poorly visualized at the initial angiography (85% vs 62%, p less than 0.01), or when the diameter of the artery bypassed was greater than 1.3 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1987

[Better acceptance of measures for induction of anesthesia after rectal premedication with midazolam in children. Comparison of results of an open and placebo-controlled study].

The rectal administration of midazolam for premedication of children before induction of anesthesia by mask was investigated in two clinical studies. In 62 children aged between 2 and 10 years, midazolam was given by open design at various dosages (0.15 mg.kg-1, 0.25 mg.kg-1, 0.30 mg.kg-1, 0.35 mg.kg-1, 0.40 mg.kg-1) to evaluate the most effective dose for optimal acceptance of the mask and gas mixture. An additional 40 children between 3 and 9 years received 0.2 mg midazolam.kg-1 body weight or placebo in a double-blind design to estimate the lower limit of efficacy of midazolam. All children were classified as ASA I and had to undergo a surgical procedure. Within the two studies the children were not different with respect to their general data, age, weight, and sex. In both studies more boys than girls were included. Parameters of efficacy were the degree of sedation before and at 10, 20, and 30 min after midazolam as well as acceptance of the mask and the gas mixture at induction of anesthesia. In all groups, including placebo, a sedative and tranquilizing effect of the premedication was found. The rectal administration of 0.35-0.4 mg midazolam.kg-1 is most suitable for the preoperative medication of children between 2 and 10 years. Due to the degree of sedation and the relief of anxiety toward the surroundings and the operation, the induction of anesthesia is optimally accepted by the child. In contrast, the effect of a dose around 0.2 mg midazolam.kg-1 body weight is not much different from that of placebo and is not sufficient for effective premedication.

Administration, Rectal↗
PubMed1987

[In utero surgery of diaphragmatic hernia in Macaca fascicularis].

The aim of this study is to be able to perform on the animal (Macacus cynomolgus) a specific in utero surgical procedure for correcting congenital diaphragmatic hernia, in order to do the same on human fetuses. The surgical technique consist in operating in utero, and to put a silastic patch on the diaphragm. A good tocolysis is very necessary to prevent early abortion. Finally the fetuses' surviving is the main problem.

Anesthesia, General↗
PubMed1986

[Percutaneous or surgical central catheters in the newborn infant].

Central microcatheters are important in neonatal intestinal surgery, as peripheral veins are quickly all used up in these patients; they are essential in maintaining a satisfactory nutritional status during the period of digestive exclusion. This retrospective study over an 18 month period concerned 105 catheters (82 central percutaneous catheters and 23 surgical catheters) put up in neonates operated on within the first few days of life. The advantages and disadvantages of both methods of catheterization were assessed by means of the infectious or mechanical complications, as well as the length of time the catheters were used. The frequency, timing and type of mechanical incidents requiring removal of the catheter were the same for both groups. There was only one septic accident, and this with a surgical catheter. An analysis of the patient files helped to decide on the best route for use in central catheterization, as well as technical improvements. Because of the absence of infectious accidents in the percutaneous series, this method was preferred, especially as it has a certain number of advantages over the surgical method. Percutaneous central microcatheterization would appear well suited to medium term parenteral feeding.

Catheterization↗
PubMed1985

[Continuous peridural anesthesia in children less than 2 years old].

Continuous epidural anaesthesia was carried out in 23 children (age 13.9 +/- 6 months, weight 9.09 +/- 2.5 kg) scheduled for long surgical procedure (soft tissue release for club-foot, "pull-through" for Hirschsprung disease, various genito-urinary procedures). The lumbar epidural space was punctured under general anaesthesia with a 19 G Tuohy needle. A graduated 24 G polyurethane catheter was then inserted and fixed. The local anaesthetic used was bupivacaine 0.25% (0.71 +/- 0.02 ml X kg-1), with or without 1:200,000 adrenaline. Five and 10 min after injection of bupivacaine, heart rate was significantly decreased (p less than 0.05) when compared with pre-induction values, but systolic blood pressure did not change. No other haemodynamic changes occurred. Analgesia was sufficient in all but two cases at incision. Mean duration of surgical procedure was 143 +/- 9.2 min. The time of the first reinjection was significantly longer if bupivacaine with adrenaline was used (116 +/- 2.34 min), when compared with bupivacaine without adrenaline (68.9 +/- 3.92 min) (p less than 0.001). No systemic analgesic was needed during the surgical procedure and anaesthesia was maintained either with halothane (inspiratory fraction less than 0.5%) or enflurane (inspiratory fraction less than 0.8%). All children were extubated at the end of the surgical procedure. The catheter was maintained in 16 children for postoperative analgesia. The first postoperative injection was given 7.1 +/- 0.45 h later. The catheter remained in situ 26.7 +/- 4.1 h. No complication was observed. Thus, during surgery, the need for systemic analgesia was avoided and a rapid and safe postoperative recovery was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗
PubMed1984

[Premedication using intrarectal midazolam. Study of effective dosage in pediatric anesthesia].

The object of this study was to determine the optimal dose of midazolam given per rectum which would produce sedation adequate for inducing inhalational anaesthesia in paediatric practice. Five doses were studied: 0.15, 0.25, 0.30, 0.35 and 0.40 mg X kg-1. The criteria used to appreciate the effectiveness of the sedation at 30 min were the change in the child's behaviour, with a scale of 6 levels, and the acceptance of the mask and anaesthetic vapours. There was a significant correlation between the dose administered and the degree of sedation, as well as between the dose administered and the lack of reaction to the mask. Significantly better results were found with the higher doses of 0.35 and 0.40 mg X kg-1, when compared with the children who had received 0.15 and 0.25 mg X kg-1. Only in the groups who received 0.35 and 0.40 mg X kg-1 were the degrees of sedation and acceptance of induction considered as adequate. The dose of 0.35 mg X kg-1 seemed to be the best dose for adequately premedicating a child.

Age Factors↗
PubMed1983

[Strabismus and amblyopia. Value of their early detection].

The authors emphasize the importance of the relations between strabismus and amblyopia. Strabismus is often the symptom which leads to the discovery of amblyopia. Amblyopia may cause strabismus, as in organic amblyopias induced by congenital lesions of the retina or visual pathways, and visual deprivation amblyopias due to corneal opacities and/or congenital cataracts. Unilateral clouding of normally transparent media (cornea, lens, vitreum) prevents normal stimulation of the retina which is necessary to the development of binocular vision. Anisometropic amblyopias also belong to this category. More often, amblyopia is the consequence of strabismus: it is then termed "functional strabismic amblyopia". Loss of the parallelism of the two visual axes disrupts the functional balance between the images received from the two eyes. The two images are different; one is suppressed. This suppression may eventually lead to amblyopia. Amblyopia was discovered in 593 of 1 757 studied cases of strabismus. Amblyopia was the cause of strabismus in 87 patients and was functional in the remaining 506. Among these latter, visual acuity was inferior or equal to 1/10 in 241 cases and between 2/10 and 7/10 in 265. 147 children in the first group and 136 in the second could be treated. Among these patients, who were treated before the age of seven, complete recovery was obtained in approximately 1/2 of cases and improvement in more than 1/4 of first group patients and 1/3 of second group patients. Results were all the better that treatment was initiated earlier and that patients were younger.(ABSTRACT TRUNCATED AT 250 WORDS)

Amblyopia↗
PubMed1983

[Surgical ligation of patent ductus arteriosus in the very-low-birth-weight premature infant].

Three recent cases of surgical closure of ductus arteriosus in very low birth weight infants (less than 1 000 g) are reported. The indications of both surgical and pharmacological closure in very low birth weight premature infants are discussed. The necessity of an early closure of a patent ductus arteriosus is now admitted in the very premature infant, but the use of indomethacin in the first days of life is often impossible because of its side-effects. The use of adapted non-invasive monitoring devices during surgery allows a better control of anaesthesia.

Anesthesia, General↗
PubMed1983

[Pulmonary edema following generalized peritonitis in a 4-year-old child].

Following a recent case of adult-type respiratory distress syndrome in a four-year old child, the rare occurrence of this pathology in visceral paediatric surgery is recalled. The few published cases do not allow a comparison of the mortality in paediatric and adult patients. The treatment is discussed, as well as the results of pulmonary function tests performed some time after the acute pulmonary episode.

Child, Preschool↗